3 Non-Surgical Options for Managing Prolapse

Learn three non-surgical options for managing prolapse from a certified women’s health expert and Pelvic Floor PT.
Dr. Marcy Crouch
Posted on
February 10, 2023
Minute Read

First Off, What is Prolapse?

Prolapse is a condition where the pelvic organs have dropped lower in the vaginal canal. There are 3 main types of prolapse:

  • Cystocele (bladder prolapse)
  • Uterocele (uterus/cervix prolapse)
  • Rectocele (rectal prolapse)

These are generally graded on a scale that has 4 parts. Being a PT, we grade these a bit differently than a Urogynecologist would grade them, but generally speaking, this is what you can expect to find:

  • Grade 1: Prolapse descends 50% of the vaginal canal with bearing down.
  • Grade 2: Prolapse comes to the opening of the vaginal canal with bearing down.
  • Grade 3: Prolapse comes past the opening of the vaginal canal.
  • Grade 4: Prolapse comes 50% outside of the vaginal canal.

Symptoms of Pelvic Organ Prolapse

The most common symptom someone with POP (Pelvic Organ Prolapse) may have is a feeling of heaviness or bogginess in the vaginal canal like something is falling out. Some women describe it as a feeling that there is a tampon right at the opening.

POP is not usually painful, per se, but can feel uncomfortable and can contribute to leaking and or constipation. Usually, if someone has a significant prolapse, like a grade 3 or 4, surgery may be needed. However, this depends on how much the prolapse is coming out and how it is affecting the woman’s life.

Being a PT, I always say we want to work our way up the ladder of treatment, so to speak, starting with the most conservative and then moving to surgery if needed.

What Causes Prolapse

There are a few reasons for POP, and they are commonly seen in women who have had babies. The pressure and weight of being pregnant along with the pushing of having a baby can lengthen and weaken the pelvic floor muscles (this is true for women who have c-sections as well).

Click HERE for more info on how pregnancy impacts your pelvic floor.

This can lead to the muscles not being as strong or rigid, and they lose their supportive function, which is what holds up those organs.

We also see POP in people with chronic constipation (think pushing and straining a lot), chronic respiratory issues (coughing a lot), or weight lifters that have put excess amounts of load and pressure on those muscles as they lift very heavy weights for a long time.

Usually, there is also a genetic factor to prolapse, some people have tissue that may be more stretchy and less rigid than others, and over time the muscles and fascia lose their “passive tone” and the organs are less supported.

Non-Surgical Options for Managing Prolapse

First things first, don’t panic. Not every case of POP is even symptomatic, nor does it cause problems. However, if your POP is causing you problems such as leaking, constipation, or discomfort “down there,” there are 3 things you can do to start supporting it without surgery as your first bet.

1) Stop straining/pushing

This is a BIG one. You want to make sure when you are having a bowel movement or lifting anything heavy, that you aren’t holding your breath or straining.

Think about your mouth and vagina as a continuous tube. Exhale through your mouth while you are lifting or pooping, and this will lessen the downward pressure on your pelvic floor muscles. Less pressure down means less pressure on the prolapse.

Check out this quick video for more info on how to properly breath while pooping!

2) Learn how to engage your foundation and strengthen your pelvic floor muscles

I’m sure you’ve heard that Kegels are the answer to everything, but guess what? It’s actually very hard to do a Kegel the right way, and we have to also think about the abdominal muscles, core, and breath when doing Kegels.

I call all of these important components “the foundation.” Doing a proper Kegel requires making sure all muscles in your pelvic floor and tummy are coordinated with your breath AND whatever movement you’re doing.

Engaging the foundation is KEY to making sure you get the best pelvic floor contraction, so your prolapse is supported and your pelvic floor muscles can actually strengthen to provide long term support.

To learn more about engaging your foundation and strengthening your pelvic floor muscles, check out our courses!

3) Try an over-the-counter pessary

Back in the day, I used to recommend that my patients insert a super tampon for a little extra “support” for prolapse. The tampon acts like an arch support for your foot if you can imagine. It’s something for the prolapse to rest against and can be helpful with activity or a day when you have to do a lot of lifting or exercising. It’s not a miracle, but can make a difference for some.

Lucky for us, Poise now makes an over-the-counter device called Impressa, which is like a large tampon but not for absorption of blood, it’s for support.

A pessary is a device that a doctor can fit you for, and it’s made of medical-grade silicon. This can help support the prolapse as well. Some patients have better results than others, but in my opinion it’s worth a try before surgery!

I hope you learned something new and that this information was helpful! If you’re ready to take charge of your recovery and learn how to strengthen your pelvic floor, my course Postpartum Power is a great place to start.

Dr. Marcy Crouch

Known as The Down There Doc on Instagram and TikTok, Dr. Marcy Crouch is a board-certified women’s health physical therapist working to elevate pregnancy and postpartum care for women everywhere.